Intraductal Spread of Pancreatic Cancer
Intraductal Spread of Pancreatic Cancer
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胰腺癌导管内扩散
DOI：
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
H. Sonoue
中科院分区：
文献类型：
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作者：
Shigetaka Yamasaki;K. Suda;B. Nobukawa;H. Sonoue
背景：胰腺浸润性导管腺癌（IDAP）也通过胰腺导管树扩散。本研究的目的是阐明IDAP伴导管内扩散的临床病理特征。方法：我们对54例IDAP患者的导管内扩散及其与临床病理参数的关系进行了研究。采用弹性van Gieson染色法确定胰管壁弹性纤维。结果：导管内癌扩散37例（69%）。这种扩散在高分化IDAP中很常见（93%），导管内癌灶的数量与肿瘤分化程度相关（p < 0.001）。大支管是导管内扩散的主要途径（64.1%）。使用Ki67评估，导管内癌成分的增殖指数低于相关浸润性癌成分（p < 0.001）。导管内扩散的存在与否与年龄、性别、肿瘤位置、肿瘤大小或分期无关。与没有导管内扩散的IDAP相比，有导管内扩散的IDAP有更长的生存期，尽管差异不显著（p = 0.092）。结论：IDAP，特别是高分化型，有导管内扩散的倾向。导管内及相关浸润性癌成分中Ki67标记指标的差异提示这些成分表现出不同的生物学行为。
Background: Invasive ductal adenocarcinoma of the pancreas (IDAP) also spreads through the pancreatic ductal tree. The aim of this study was to clarify the clinicopathologic features of IDAP with intraductal spread. Methods: We studied the intraductal spread of IDAP and its correlation with clinicopathologic parameters in a surgical series of 54 patients. The pancreatic ducts were analyzed by confirmation of mural elastic fibers with elastica van Gieson stain. Results: Intraductal spread of carcinoma was identified in 37 patients (69%). Such spread was frequent in well-differentiated IDAP (93%), and the number of intraductal carcinoma foci was correlated with the grade of tumor differentiation (p < 0.001). The large branch ducts were the main route of intraductal spread (64.1%). The proliferation index, evaluated using Ki67, was lower in the intraductal carcinoma components than in the associated infiltrating carcinoma components (p < 0.001). The presence or absence of intraductal spread was not correlated with age, sex, tumor location, tumor size, or stage. IDAP with intraductal spread showed a tendency, although it was not significant (p = 0.092), to be associated with longer survival compared with IDAP without intraductal spread. Conclusion: IDAP, especially of the well-differentiated type, has a tendency to spread intraductally. The difference between the Ki67 labeling indexes in the intraductal and associated infiltrating carcinoma components suggests that these components show different biological behaviors.